7 Exercise Depending on the environment and on the group of participants, the facilitator can start by hearing their traumatic experiences and how they felt emotionally, physically and behaviourally. The facilitator can then normalise feelings during the presentation and by citing examples from the narrations given. POST-TRAUMATIC STRESS DISORDER (Mini lecture and discussion) Post-traumatic stress disorder (PTSD) is a serious anxiety disorder resulting from particularly stressful events, such as military combat, rape, natural disaster, violence and torture. The symptoms related to PTSD include: • • • • • Intrusive experiencing of the trauma; Numbing of responsiveness to the outside world; Estrangement from others; A tendency to be easily startled; and Nightmares, recurrent dreams, and otherwise disturbed sleep. Symptoms of PTSD usually start six months or longer after exposure to the traumatic event. Exposure to the traumatic events is almost always associated with feelings of fear, helplessness and horror. A stressor is more likely to produce PTSD if it is severe, sudden, unexpected, prolonged, repetitive and intentional. Symptoms of PTSD include persistently re-experiencing symptoms, symptoms of persistent avoidance and numbing of general responsiveness, and persistent symptoms of increased arousal. Re-experiencing symptoms People who have been traumatised often re-experience the traumatic event. One may have unwanted thoughts of the trauma and find that one is unable to get rid of these thoughts. Some people have flashbacks or very vivid images, as if the trauma is occurring again. Nightmares are also common. These symptoms occur because a traumatic experience is so shocking and so different from everyday experiences that one cannot fit it into what one knows about the world. In order to understand what happened, one’s mind keeps bringing the memory back, as if to digest it and fit it in. Fear and anxiety Anxiety is a common and natural response to a dangerous situation. For many, it lasts long after the trauma has ended. This happens when one’s view of the world and sense of safety have changed. Anxiety may also be triggered by certain places, times of day, noises or smells, or any situation that reminds one of the trauma. Increased arousal This includes feeling jumpy, jittery and shaky, being easily startled, and having trouble concentrating or sleeping. Continuous arousal can lead to impatience and irritability, Module 7: Dealing with trauma, psychological healing and support 111